Is it time for more rheumatologists to embrace osteoarthritis?

There has been a degree of apathy or even antipathy towards osteoarthritis (OA) by UK rheumatologists, the origin of which is hard to elucidate. Clinical research in OA has historically not been regarded as the highest priority by UK funding bodies [1]. The paucity of evidence-based therapy, particularly disease-modifying OA drugs (DMOADs), may have led to OA patients being a source of frustration for clinicians whose clinics are already bulging in addressing the challenges of inflammatory arthritis. The previous attempts of enthusiasts to nurture interest in OA have fallen by the wayside; for example, a previous incarnation of an OA Special Interest Group at the British Society for Rheumatology (BSR) Annual General Meeting was characterized by a small number of devotees and tumbleweed whistling through an otherwise deserted room. What, if anything, has changed?

There are a number of answers to this question. Firstly, the Arthritis Research Campaign (arc) is taking a more progressive approach to clinical research, including OA: as much is now being directed towards projects for weight loss, exercise or rehabilitation, and vitamin D therapy for knee pain and hand OA as previously supported molecular studies [2]. Similarly, there are major initiatives in the USA, including the National Institutes for Health-funded Glucosamine/chondroitin Arthritis Intervention Trial (GAIT) [3] and the $8.9 million Osteoarthritis Initiative, a 7-yr project to recruit 5000 people at risk of OA of the knee, examining predictors including biomarkers [4]. The controversy surrounding the two industry-sponsored trials suggesting glucosamine sulphate may be a DMOAD [5, 6] has certainly raised awareness among rheumatologists of the problem. The EULAR recommendations for the management of knee [7] and hip [8] OA and the MOVE consensus for the role of exercise in the management of OA of the hip or knee [9] have made the task of managing OA less daunting. Patients are also better informed, using resources like Arthritis Care's OA Nation report [10] to understand the impact of their problems and the interventions available through conventional and complementary medicine.

It is against this background that a group of OA enthusiasts met under the auspices of the BSR in Edinburgh 2004, including some who remembered the previous OA Special Interest Group, but came anyway. The event was notable not just for the eminence of the speakers and quality of the debate: rather it was the popularity of the session that overwhelmed. An equal number of putative attendees were turned away as were able to fit into a room of admittedly modest dimensions. The proceedings are reported elsewhere, but the initiative has been distilled by due democratic process into a discrete set of objectives for the OA Special Interest Group, to:

• Promote development and dissemination of relevant guidelines and research

• Promote public information about osteoarthritis

• Implement changes of best clinical practice

• Compile a database of OA research and coordinate collaborative studies

• Determine future directions of research in OA.

Such an explicit list allows the progress of the Special Interest Group to be measured. Indeed, there is already some evidence of movement towards some of these goals: the management of OA has been added to the list of topics for appraisal by the National Institute of Clinical Excellence [11] (NICE) by a process which included consultation with the Arthritis and Musculoskeletal Alliance (ARMA) and other stakeholders. The Primary Care Rheumatology Society's Annual Conference in 2004 included workshops on pain management and exercise in OA, plus a debate on pain management in OA led by Peter Croft. An excellent CD-ROM is now available to illustrate the EULAR recommendations for the management of knee OA in general practice [12], which is suitable for integrating in local Primary Care educational updates (rather than always teaching about inflammatory arthritis, which each general practitioner sees comparatively rarely). The database and research strategy are in a relatively early stage, but progress will be reviewed regularly, including at the next OA Special Interest Group meeting in Birmingham.

What does this mean for Rheumatologists? First and foremost, the Special Interest Group provides a forum where there will be access to the most up-to-date information on OA and strategies for implementing best practice in the area covered by their rheumatology service. Secondly, the rheumatologist can fulfil a pivotal role in disseminating OA guidelines and educating the musculoskeletal team and primary care colleagues through their educational network. Thirdly, the relationship of the local population with their rheumatologist allows the public to learn about OA and the rheumatologist to give lifestyle and exercise advice on occasions when invited to speak to meetings or education groups, which can reinforce central public health messages, such as the government's recent drive against obesity [13]. The minority who has a genuine research interest can also engage in the database or collaborative studies. All of these topics will be addressed at the next OA Special Interest Group at the BSR meeting in Birmingham: we extend a warm invitation to all.

The authors have declared no conflicts of interest.

References

Author notes

Musculoskeletal Research Group, University of Newcastle upon Tyne, Rheumatology, Wansbeck General Hospital and Musculoskeletal Unit, Freeman Hospital, Newcastle upon Tyne, 1MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, 2MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, 3Academic Unit of Musculoskeletal Disease and Rehabilitation, University of Leeds, Leeds General Infirmary, Leeds, 4MRC Health Services Research Collaboration, University of Bristol, Bristol and 5Academic Rheumatology, University of Nottingham, Nottingham City Hospital, Nottingham, UK